Kim S-H, Kee S Y, Lee D-G, Choi S-M, Park S H, Kwon J-C, Eom K-S, Kim Y-J, Kim H-J, Lee S, Min C-K, Kim D-W, Choi J-H, Yoo J-H, Lee J-W, Min W-S
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Transpl Infect Dis. 2013 Feb;15(1):49-59. doi: 10.1111/tid.12003. Epub 2012 Sep 24.
In allogeneic stem cell transplantation (allo-SCT), reduced-intensity conditioning (RIC) is known for producing less regimen-related toxicity. However, whether or not RIC reduces the risk for infection and infection-related mortality (IRM) remains controversial.
We retrospectively analyzed infectious episodes and IRMs after allo-SCTs by time period and by the intensity of the conditioning regimen (RIC [n = 81] vs. myeloablative conditioning, MAC [n = 150]).
The cumulative incidence of any kind of infection was lower in the RIC group through the entire period (72% vs. 87%; P = 0.007). The onset of infections was deferred in the RIC group as compared with the MAC group (P = 0.012). Bacteremia occurred less frequently in the RIC group through the entire period (5% vs. 14%; P = 0.044). However, the incidences of cytomegalovirus reactivation and disease, herpes zoster, virus-associated hemorrhagic cystitis, and invasive fungal infection were not different between the two groups. Furthermore, there was no difference in relapse-free survival and IRM between the two conditioning regimens.
Careful monitoring and appropriate preventive/therapeutic strategies for infectious complications, comparable to those for allo-SCT recipients with MAC, should also be applied to those with RIC, especially after engraftment.
在异基因干细胞移植（allo-SCT）中，降低强度预处理（RIC）因产生较少的预处理相关毒性而闻名。然而，RIC是否能降低感染风险和感染相关死亡率（IRM）仍存在争议。
我们回顾性分析了allo-SCT后按时间段和预处理方案强度（RIC [n = 81] 对比清髓性预处理，MAC [n = 150]）划分的感染发作情况和IRM。
在整个时间段内，RIC组中任何类型感染的累积发生率较低（72% 对比87%；P = 0.007）。与MAC组相比，RIC组感染的发作延迟（P = 0.012）。在整个时间段内，RIC组菌血症的发生频率较低（5% 对比14%；P = 0.044）。然而，两组之间巨细胞病毒再激活和疾病、带状疱疹、病毒相关性出血性膀胱炎以及侵袭性真菌感染的发生率并无差异。此外，两种预处理方案在无复发生存率和IRM方面没有差异。
对于RIC患者，尤其是在植入后，应像对接受MAC的allo-SCT受者一样，对感染并发症进行仔细监测并采取适当的预防/治疗策略。
